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5 Things Every Person Should Know About Osteoporosis

08/14/23 Marcy B. Bolster, MD, Harvard Medical School|Massachusetts General Hospital;

Picture a woman in her early 20s walking up to her front door after a snowstorm. She slips on the ice and falls on her side on the concrete walkway. In that situation, the chances of the young woman suffering a serious injury are relatively low. Now picture the same scenario, only with a woman in her 80s. Her risk of serious injury and a potential medical emergency is far greater.

As we get older, our bone density and bone strength diminish. In some people, that decrease can lead to osteoporosis — a condition in which a decrease in the density of bones weakens the bones, making breaks (fractures) more likely.

There are other risk factors for osteoporosis, but aging is one of the most common. As you get older, it’s important to understand osteoporosis and start talking to your doctor about your risks and preventive measures you can take.

Here are five things everyone should know about osteoporosis to help prepare for conversations with your doctor.

Osteoporosis is far more common in females

During menopause, a woman’s estrogen levels decrease, which contributes to a drop in bone density. That makes the risk of osteoporosis greater for postmenopausal females. In fact, almost 50% of females aged 50 years and over compared with almost 25% of males aged 50 years and over will suffer an osteoporotic fracture in their lifetime. Men lose bone density as they age, but they typically start with a higher bone density and do not share this same significant risk factor.

There is a genetic component to osteoporosis

In addition to sex and age, there is likely a genetic component to the condition. One of the most significant osteoporosis risk factors is having a parent who has experienced a hip fracture.

Other factors that increase a person’s chances of getting osteoporosis include a diet low in calcium and vitamin D, a sedentary lifestyle, cigarette smoking, excessive alcohol consumption, taking certain medications such as corticosteroids (for example, prednisone) and breast cancer medications (such as aromatase inhibitors), and having rheumatoid arthritis.

Osteoporosis often has no symptoms

Osteoporosis is often referred to as a silent threat. That’s because a person can’t feel their bone density diminishing. Often, the first “symptom” of osteoporosis is when a person has what’s known as a fragility fracture. Fragility fractures are fractures that result from a fall from a standing height or less and include a fall out of bed; these falls normally would not cause a fracture in a healthy bone. Although fractures are often the first symptom experienced by a patient with osteoporosis, it is surprising to consider that approximately two thirds of vertebral (spine) fractures are asymptomatic. These fractures are typically incidentally detected on imaging tests.

There is a test to screen for osteoporosis

Screening is an important detection tool for adults before a fracture occurs. These screenings are done via a bone density test.

The Bone Health and Osteoporosis Foundation recommends screenings for all females aged 65 and older and all men aged 70 and older. People with specific risk factors (such as a family history of osteoporosis or excessive alcohol consumption) and anyone who has broken a bone when older than age 50 are also recommended to start screenings earlier.

On average, menopause occurs at around age 51 among females in the United States. That means there’s a significant gap between bone density loss and the recommended age to start screening. It’s especially important for females to talk to their doctors about their risks and prevention steps during this time.

There are ways to prevent and treat osteoporosis

It’s not realistic to prevent bone loss from occurring, but there are steps people can take at every age to reduce their risk of osteoporosis. Peak bone mass occurs by age 30 years. Anyone under 30 should make sure they’re getting enough calcium and vitamin D in their diet and lead an active lifestyle to ensure their bones are as healthy as possible.

As people get older, they should focus on managing risk factors like tobacco and alcohol use and engaging in weight-bearing exercise, including walking and lifting weights. Additionally, there are highly effective medications that can prevent bone loss and build bone. Doctors will tell you about the potential complications from these medicines, which are very rare, and what they will do to limit your chances of having any of them. In almost all cases, the benefits from treating osteoporosis far outweigh the risks.

The final piece of the prevention puzzle includes changes to your lifestyle and surroundings that are important for fall prevention and can thus help prevent that first fracture. After a person has a fracture, their risk of subsequent fractures increases dramatically. Early detection, combined with steps like removing trip hazards and avoiding situations where falls are more likely, is essential.

For more on osteoporosis, visit the Manuals page or the Quick Facts page on the topic.